Premium
Active surveillance for early‐stage prostate cancer
Author(s) -
Dall'Era Marc A.,
Cooperberg Matthew R.,
Chan June M.,
Davies Benjamin J.,
Albertsen Peter C.,
Klotz Laurence H.,
Warlick Christopher A.,
Holmberg Lars,
Bailey Donald E.,
Wallace Meredith E.,
Kantoff Philip W.,
Carroll Peter R.
Publication year - 2008
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.23373
Subject(s) - medicine , prostate cancer , watchful waiting , stage (stratigraphy) , psychosocial , oncology , natural history , cancer , prostate specific antigen , active monitoring , overdiagnosis , prostate cancer screening , gynecology , paleontology , real time computing , psychiatry , computer science , biology
The natural history of prostate cancer is remarkably heterogeneous and, at this time, not completely understood. The widespread adoption and application of prostate‐specific antigen (PSA) screening has led to a dramatic shift toward the diagnosis of low‐volume, nonpalpable, early‐stage tumors. Autopsy and early observational studies have shown that approximately 1 in 3 men aged >50 years has histologic evidence of prostate cancer, with a significant portion of tumors being small and possibly clinically insignificant. Utilizing the power of improved contemporary risk stratification schema to better identify patients with a low risk of cancer progression, several centers are gaining considerable experience with active surveillance and delayed, selective, and curative therapy. A literature review was performed to evaluate the rationale behind active surveillance for prostate cancer and to describe the early experiences from surveillance protocols. It appears that a limited number of men on active surveillance have required treatment, with the majority of such men having good outcomes after delayed selective intervention for progressive disease. The best candidates for active surveillance are being defined, as are predictors of active treatment. The psychosocial ramifications of surveillance for prostate cancer can be profound and future needs and unmet goals will be discussed. Cancer 2008. © 2008 American Cancer Society.